呼吸商在营养支持严重多发伤患者中的预后价值。

Prognostic value of respiratory quotients in severe polytrauma patients with nutritional support.

机构信息

Department of Biological and Medical Sciences, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic; Department of Research and Development, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.

Department of Surgery, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic.

出版信息

Nutrition. 2018 May;49:90-95. doi: 10.1016/j.nut.2017.10.013. Epub 2017 Nov 7.

DOI:10.1016/j.nut.2017.10.013

PMID:29500970

Abstract

OBJECTIVE

The association between energy metabolism and prognosis in polytrauma patients has not yet been defined. The aim of this study was to describe energy metabolism and analyze the prognostic value of respiratory quotient (RQ) and nonprotein respiratory quotient (npRQ) in fasting polytrauma patients (fPP) and polytrauma patients with nutritional support (nsPP).

METHODS

Twenty-two polytrauma patients (before and after parenteral nutrition administration) and 22 healthy controls (after overnight fasting) were examined on day 4 (median) after admission to the intensive care unit. To evaluate energy expenditure in nsPP and resting energy expenditure in fPP and controls with RQ and npRQ in all groups, we used indirect calorimetry. With regression analysis, the descriptive models of intensive care unit (ICU) length of stay (LOS) and mechanical ventilation time (VT) were derived.

RESULTS

RQ and npRQ were significantly lower in fPP than in controls (P < 0.05 and P < 0.01, respectively) and in nsPP (P < 0.05). In nsPP, relationships between RQ or npRQ and the ICU LOS or mechanical VT were demonstrated (P < 0.0001, r = -0.78 for RQ and VT; P < 0.0001, r = -0.78 for npRQ and VT; P < 0.001, r = -0.69 for RQ and LOS; P < 0.001, r = -0.72 for npRQ and LOS).

CONCLUSIONS

RQ and npRQ parameters measured by indirect calorimetry in polytrauma patients with parenteral nutrition on the fourth day of ICU stay related to clinical outcomes such as duration of mechanical ventilation and ICU LOS.

摘要

目的

能量代谢与多发创伤患者预后之间的关系尚未明确。本研究旨在描述能量代谢，并分析空腹多发创伤患者（fPP）和接受营养支持的多发创伤患者（nsPP）的呼吸商（RQ）和非蛋白呼吸商（npRQ）的预后价值。

方法

22 例多发创伤患者（在接受肠外营养前后）和 22 例健康对照者（在接受隔夜禁食后）于入住重症监护病房第 4 天（中位数）接受检查。为了评估 nsPP 中的能量消耗和 fPP 中的静息能量消耗以及各组中的 RQ 和 npRQ，我们使用间接测热法。通过回归分析，得出重症监护病房（ICU）住院时间（LOS）和机械通气时间（VT）的描述性模型。

结果

fPP 中的 RQ 和 npRQ 明显低于对照组（P<0.05 和 P<0.01）和 nsPP（P<0.05）。在 nsPP 中，RQ 或 npRQ 与 ICU LOS 或机械 VT 之间存在相关性（P<0.0001，RQ 与 VT 呈负相关，r=-0.78；P<0.0001，npRQ 与 VT 呈负相关，r=-0.78；P<0.001，RQ 与 LOS 呈负相关，r=-0.69；P<0.001，npRQ 与 LOS 呈负相关，r=-0.72）。